A practical approach to establishing a critical care outreach service: An expert panel research design

Williams, G.; Pirret, Alison; Credland, Nicola; Odell, Mandy; Raftery, Chris; Smith, Duncan; Winterbottom, Fiona; Massey, Debbie

doi:10.1016/j.aucc.2022.01.008

Cited by 4 publications

(3 citation statements)

References 107 publications

(161 reference statements)

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“…The nurses' development, consolidation and use of higher-order thinking skills is imperative in promoting patient safety (Connor et al, 2023;Levett-Jones et al, 2010;Williams et al, 2022). Our findings also indicate the benefit of standardised responses to patient deterioration as well as the need for higher-order thinking.…”

Section: Discussionsupporting

confidence: 52%

The impact of mandated use early warning system tools on the development of nurses' higher‐order thinking: A systematic review

Flenady,

Connor,

Byrne

et al. 2024

Journal of Clinical Nursing

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AimAscertain the impact of mandated use of early warning systems (EWSs) on the development of registered nurses' higher‐order thinking.DesignA systematic literature review was conducted, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and checklist (Page et al., 2021).Data SourcesCINAHL, Medline, Embase, PyscInfo.Review MethodsEligible articles were quality appraised using the MMAT tool. Data extraction was conducted independently by four reviewers. Three investigators thematically analysed the data.ResultsOur review found that EWSs can support or suppress the development of nurses' higher‐order thinking. EWS supports the development of higher‐order thinking in two ways; by confirming nurses' subjective clinical assessment of patients and/or by providing a rationale for the escalation of care. Of note, more experienced nurses expressed their view that junior nurses are inhibited from developing effective higher‐order thinking due to reliance on the tool.ConclusionEWSs facilitate early identification of clinical deterioration in hospitalised patients. The impact of EWSs on the development of nurses' higher‐order thinking is under‐explored. We found that EWSs can support and suppress nurses' higher‐order thinking. EWS as a supportive factor reinforces the development of nurses' heuristics, the mental shortcuts experienced clinicians call on when interpreting their subjective clinical assessment of patients. Conversely, EWS as a suppressive factor inhibits the development of nurses' higher‐order thinking and heuristics, restricting the development of muscle memory regarding similar presentations they may encounter in the future. Clinicians' ability to refine and expand on their catalogue of heuristics is important as it endorses the future provision of safe and effective care for patients who present with similar physiological signs and symptoms.ImpactThis research impacts health services and education providers as EWS and nurses' development of higher‐order thinking skills are essential aspects of delivering safe, quality care.No Patient or Public ContributionThis is a systematic review, and therefore, comprises no contribution from patients or the public.

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Section: Discussionsupporting

confidence: 52%

The impact of mandated use early warning system tools on the development of nurses' higher‐order thinking: A systematic review

Flenady,

Connor,

Byrne

et al. 2024

Journal of Clinical Nursing

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“…They appeared to be working in silos, with nurses having to bring the recommendations made by the ICUONs to these doctors' attention. This result is a little surprising because it is reasonable to expect that ICUONs engage in discussions with the junior doctors as they assist these doctors and highlight the treatments to be considered in the early management of patient deterioration (Williams et al, 2022). Furthermore, there was little mention in the study about the involvement of the ICUONs in issues surrounding patient treatment decisions, apart from escalation to the ICU physician where they deemed it necessary.…”

Section: Discussionmentioning

confidence: 99%

Automated rapid response system activation—Impact on nurses' attitudes and perceptions towards recognising and responding to clinical deterioration: Mixed‐methods study

Chua

Wee

Lim

et al. 2023

Journal of Clinical Nursing

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AimTo explore general ward nurses' attitudes and perceptions towards recognising and responding to clinical deterioration in a hospital with automated rapid response system activation.BackgroundThere is growing interest in deploying automated clinical deterioration notification systems to reduce delayed or failed recognition and response to clinical deterioration of ward patients. However, little is known about its impact on ward nurses' perspectives and work patterns.DesignA mixed‐methods study.MethodsOnline survey of 168 registered nurses and individual interviews with 10 registered nurses in one acute hospital in Singapore. The study adhered to the STROBE checklist for cross‐sectional studies and the COREQ guidelines for qualitative studies.ResultsMany nurses (38.1%) rarely performed patient assessments or observations other than vital signs assessment to assess for early signs of clinical deterioration. About 30% were worried about being criticised for calling the primary team doctors. Four themes emerged from the qualitative analysis: automated rapid response system activation as a safety net, being more cautious with vital signs monitoring, the NEWS2 alone is inadequate, and ward nurses as the ‘middleman’ between the intensive care unit outreach nurse and primary team doctors.ConclusionsAlthough nurses value the automated rapid response system activation as a safety net to minimise delays in accessing urgent critical care resources, it does not address the sociocultural barriers inherent in escalation of care. Although the automated system led nurses to be more cautious with vital signs monitoring, it does not encourage them to perform comprehensive patient assessments to detect early signs of deterioration.Relevance to clinical practiceNurse education on assessing for clinical deterioration should focus on the use of broader patient assessment skills other than vital signs. Sociocultural barriers to escalation of care remain a key issue that needs to be addressed by hospital management.No patient or public contributionNo patients, service users, care‐givers or members of the public were involved in the study.

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“…When criteria are breached, staff are prompted to escalate care; that is, to increase the frequency of vital signs monitoring and to contact a more senior colleague or a practitioner with expertise in the management of critical illness (e.g. a doctor or a nurse from critical care outreach team or equivalent) [9,10]. In the UK and parts of Europe, the National Early Warning Score (NEWS) has been widely implemented and its predictive performance validated [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Selecting intervention content to target barriers and enablers of recognition and response to deteriorating patients: an online nominal group study

Smith

Cartwright

Dyson

et al. 2022

BMC Health Serv Res

Self Cite

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Background Patients who deteriorate in hospital wards without appropriate recognition and/or response are at risk of increased morbidity and mortality. Track-and-trigger tools have been implemented internationally prompting healthcare practitioners (typically nursing staff) to recognise physiological changes (e.g. changes in blood pressure, heart rate) consistent with patient deterioration, and then to contact a practitioner with expertise in management of acute/critical illness. Despite some evidence these tools improve patient outcomes, their translation into clinical practice is inconsistent internationally. To drive greater guideline adherence in the use of the National Early Warning Score tool (a track-and-trigger tool used widely in the United Kingdom and parts of Europe), a theoretically informed implementation intervention was developed (targeting nursing staff) using the Theoretical Domains Framework (TDF) version 2 and a taxonomy of Behaviour Change Techniques (BCTs). Methods A three-stage process was followed: 1. TDF domains representing important barriers and enablers to target behaviours derived from earlier published empirical work were mapped to appropriate BCTs; 2. BCTs were shortlisted using consensus approaches within the research team; 3. shortlisted BCTs were presented to relevant stakeholders in two online group discussions where nominal group techniques were applied. Nominal group participants were healthcare leaders, senior clinicians, and ward-based nursing staff. Stakeholders individually generated concrete strategies for operationalising shortlisted BCTs (‘applications’) and privately ranked them according to acceptability and feasibility. Ranking data were used to drive decision-making about intervention content. Results Fifty BCTs (mapped in stage 1) were shortlisted to 14 (stage 2) and presented to stakeholders in nominal groups (stage 3) alongside example applications. Informed by ranking data from nominal groups, the intervention was populated with 12 BCTs that will be delivered face-to-face, to individuals and groups of nursing staff, through 18 applications. Conclusions A description of a theory-based behaviour change intervention is reported, populated with BCTs and applications generated and/or prioritised by stakeholders using replicable consensus methods. The feasibility of the proposed intervention should be tested in a clinical setting and the content of the intervention elaborated further to permit replication and evaluation.

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A practical approach to establishing a critical care outreach service: An expert panel research design

Cited by 4 publications

References 107 publications

The impact of mandated use early warning system tools on the development of nurses' higher‐order thinking: A systematic review

The impact of mandated use early warning system tools on the development of nurses' higher‐order thinking: A systematic review

Automated rapid response system activation—Impact on nurses' attitudes and perceptions towards recognising and responding to clinical deterioration: Mixed‐methods study

Selecting intervention content to target barriers and enablers of recognition and response to deteriorating patients: an online nominal group study

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